Preview
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
EXHIBIT “G”
EXHIBIT “G”
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
----X Index No.: 152948/2020
JOSEPH ITARA and TABETHA ITARA,
Plaintiffs, RESPONSE TO
DEMANDS FOR
-against- DISCOVERY &
INSPECTION
MASARYK TOWERS CORPORATION d/b/a
MASARYK TOWERS MANAGEMENT,
Defendants.
----- ----------------------------.----.----..---------X
COUNSELLORS:
Plaintiff JOSEPH ITARA as and for his Response to the demands of the defendanta
MASARYK TOWERS CORPORATION d/b/a MASARYK TOWERS MANAGEMENT
Demands for Discovery & Inspection, sets forth as follows:
EABILSTATEM_1EET.E
None other than the accident report defense counsel exchanged.
TELEMEDICINE RECORDS
All authorizations provided include all medical records, which includes those taken by
telemedicine.
MOTICE TO PRODUCE AND PRESERVE
Attached are 5 color copies of photographs of the type of boots plaintiff was wearing at
the time of the sccident. Plaintiff is unsure whether these were the same boots he wore at the
time of the accident.
SUBSEQUENT INJIJRIES
None.
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
MEDICAL AUTHORIZATIONS
Steven Touliopoulos- Orthopedics of NY, PLLC
University
31"
23-25 Street, Suite 800
Astoria, New York 11105
Surgicare of
Manhattan
2nd 7th
800 Avenue, Floor
New York, NY 10017
Dr. Daniel Klein
79th
229 East
New York, NY 10075
EMPLOYMENT RECORDS
Annexed hereto is a duly-executed authorization to obtain the plaintiff JOSEPH ITARA's
employment W-2 wage statements and attendance records from 8/13/2017-
records, specifically
present, from:
Centers1ial Elevator Industries
47th
24-35 Street
Astoria, NY 11103
MARRIAGE CERTIFICATE
plaintiffs'
Annexed hereto is a copy of the marriage certificate.
Dated: Westchester, New York
June 2, 2021
BRAND BRAND NOMBERG
& ROSENBAUM, LLP
Attorneys for the Plaintifs
By: Brett J. Nomberg, Esq.
7th
622 Third Ave, Floor
New York, NY 10017
Tel. (212) 808-0448
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
TO:
MILBER MAKRIS PLOUSADIS & SEIDEN, LLP
Attorneys for the Defendant
MASARYK TOWERS CORPORATION d/b/a
MASARYK TOWERS MANAGEMENT
1000 Woodbury Road, Suite 402
Woodbury, NY 11797
(516)712-4000
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
. ^ *
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
L
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
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FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
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FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
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FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
OCA Official Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Depadment of Health]
Patient Name Date of Birth Social Security Number
JOSEPH ITARA 974
Patient Address
520 West 56th Street, Apt 8D, New York, NY 10019
I, or my authorized representative, request that health kfesscicñ regarding my care and tmatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and AccomeiPy Act of 1996
(HIPAA), I understand that:
I. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
HIV* RELATED
TREATMENT, except psychotherapy notes, and CONFIDENTIAL INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health inicññation described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such infañaaticñ to the person(s) indicated in Item 8.
2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the acipient is
prohibited from redisclosing such infarmation without my authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related ½hra=*½a without authorization. If
I experience disd-i=±ª-r.. because of the release or disclosure of HIV-related information, I may contact the New York State Division
of Human at (212) 480-2493
Rights or the New York City Commission of Human Rights at (212) 306-7450. These agencies are
responsible for protecthg my rights.
3. I have the right to revoke this authorization at eny time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATI'ORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b).
7. Name and address of health provider to release this information:
Ñ
or entity
WNoiÅC f6dn5Ô AtS ÑLi 23-26 D-h i SR.DÛ Å5% 4/Ô6
8. Name and address of person(s) or person to whom this information will be sen
9(a). Specific information to be released:
Q Medical Record from (insert date) to (insert date)
a Entire Medical Record, ire!üdkg patient histories, officenotes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
O Other: Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) Q By MM•!!q here I authorize
s Name of individual health care provider
to discuss my health im•*ien with my attorney, or a govemmental agency, listed here:
(Attomey/Firm Name or Govemmental Agency Narne)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
Q At request of individual
@ Other: litigation requirement end of litigation
12. If not the patient, name of person signing fotrn: 13. Authority to sign on behalf of patient
All items on this form have been completed and my questions about this form have been answered. In edditis, I have been provided a
copy of the form.
too /O
.tt Date: 7 Z / Z
i of patient or representative authorized by law.
* Haman Immunodeficiency Viras that causes AIDS. The New York State Pablie Health aw protects information which reasonably could
someone as having HIV symptoms or ingsetlem and inibrmation
identify regarding a persea's contacts,
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
OCA Official Form No.: 9dio
AUTHORIZATION FOR RELEASE OF HEALTH DiFORMATION PURSUANT TO HIPAA
|This ferm has been approved by the New York State Department of Health)
Patient Name Date of Birth Soci urity Number
JOSEPH ITARA 1974 713
Patient Address
520 West 56th Street, Apt SD, New York, NY 19019
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accc=±i!!•y Act of 1996
(HIPAA), I understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
HIV*
TREATMENT, except psychotherapy notes, and CONFIDENTIAL RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of infbrmation, and I
iaitial the line on the box in Item 9(a), I specifically authorize release of such inicitñâtica to the person(s) indicated in Item 8.
2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
pmMbi'M from redisclosing such information without my authorization unless parinitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Comminian of Human Rights at (212) 306-7450. These agencies are
responsible for protecting my rights.
3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or c::pt!iity for
benefits not be conditioned
will upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclasure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU 10 DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATIORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b).
7. Name and address o health provide o entity to release this info ation:
8.Name and dress of person(s) or category of person to whom this information will be sent:
3ÂFr 15 ŸlClM i5 Å $d t tÚ70 O Piu f00t ${d†t 402-
j Mod My ( Ï O47
9(a). Specific information to be released:
O Medical Record from (insert date) to (insert date)
B Entitt Medical Record, including patient histories, notes (except psychatharany
office notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
0 Other: Include: (Imticate by Initialing)
Alcohol/Drug Treatament
Mental Health Information
Authorisation to Diseuss Health Information HIV-Related Information
(b) O By initialing here I authorize
Initials Name ofindividual health care pmvider
to discuss my health information with my attomey, or a govemmental agency, listed here:
(Attomey/Firm Name or Govemmental Agency Namc)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
0 At request of individual
@ Other litigadon requirement end of litigation
12. If not the patient, name of person signing fbrm: 13. Authority to sign on behalf of patient:
All items on this form have been camph*M and my questions about this ibnn have been answered. In addition, I have been pmvided a
copy of the form.
gnature f patient or representative authorized by law.
* Human Immunodeficiesey Virns that causes AIDS. The New York State Publie Health Law protects information whieb reasonably could
someone as having HIV symptoms or inibction and Information regarding a person's contacts.
identify
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
OCA OBicial Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form bas been approved by the New York State Department of Health]
Patient Name Date of Birth Number
JOSEPH ITARA 1974 713
Patient Address
520 West 56th Street, Apt SD, New York, NY 10019
I, or my authorized representative, request that health i+-•% regarding my care and tr=tm=t be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance P~*•hility and A~•~=*Amty Act of 1996
(HIPAA), I understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
except psychotherapy HIV* RELATED
TREATMENT, notes, and CONFIDENTIAL INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of hfe--don, and I
initial the line on the box in Item 9(a), I specifically authorize release of such hfa---ation to the person(s) Indicated in Item 8.
2. If I am authorizing the release of HIV-related, alcohol or dmg treatment, or mental health treatment information, the recipient is
prohibited ilrom reisdsisg such information without my authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related infc-.":: without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are
responsible for protecting my rights.
3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, in a health plan, or eligibilitymW*
for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE _OTHER THAN THE ATfORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
to release this inform::tiom
g
7. Name and address of health provider or entity
(ìr-bwd id 229 Gast #$hedi N a ¾# 4075
8. Name and address of erson(s) or category of person to whom this ½-a*ion will be so t:
li f \5 ÊÍdúb1 (5 h#2GA LL f / 1 Di) Woalbge.oad suA w24 k9 m/ its
9(a). Specific information to be released:
0 Medical Record from (insert date) . to (insert date)
Entire Medical Record, hehdes patient histories, office notes (except psyche±~•py notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
O Other: Include: (Indicate by Initiating)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By inith!iag here I authorize
I tals Name of individual health care pmvider
to discuss my health liifctitiation with my attomey, or a g-caa=ntal agency, listed here:
(Attorney/Finn Name or Govemmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
0 At request of individual
a Other: litigation requiremnent end of litigation
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient·
All items on this form have been completed and my questions about this form have been •.a.-a-d. in addition, I have been provided a
copy of the form.
.- 4i
mas dÄhÅ Date: 7 2/ 2 //
agnatu of pation or representative authorized by law.
* Human imm••-deff clemey Virus that causes AIDS. The New York State Pablie ealth Law protects information which reasonably could
identi$ someone as baving HIV symptoms or infhction and laformation regarding a person's contacts.
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
OCA Ofileial Form No.: 960
AUTHORIZATION FOR RELEASEOF HEALTH INFORMATION PURSUANT TO HIPAA
[This form bas been appmved by the New York State Department of Health]
Patient Name Date of Birth Social Security Number
JOSEPH ITARA 974
Patient Address
_520 West 56th Street, Apt 8D, New York, NY 10019
I, or my e±e±•d representative, request that health
B- regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 19%
(HIPAA), I understand that:
1. This authorization may include discloswe of info=cti= relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
HIV*
TREATMENT, except pt--hetherapy notes, and CONFIDENTIAL RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health infama*ian described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
prohibited from redisclosing such information without authnriwinn unless pc=it‡cd to do so under federal or state law. I
my
understand that I have the right to request a list of people who may receive or use my HIV-related Lafen==‡ica without authorization. If
I experience discrimin=+ian because of the release or disclosure of HIV-related information, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Hurnan Rights at (212) 306-7450. These agencies are
responsible for protecting my rights.
3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke except to the extent that action has already been taken based on this authorization.
this authorization
4. I understand that signing this authorization is voluntary. My treatment payment, er!!me=± in a health plan, or cliphility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this e"d-^±±= might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATfORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b).
7. Name and address of health provider or entity to release this information:
8. Name address of person(s) or category of person to whom this infe==•ion will be sent:
ÎÓ l bT 0Wl a PÔW1 .LÊ/ / (flb kidblis - it
g ()0ÔÏ7¼rt / K777
9(a). Specific infcmetion to be released:
0 Medical Record from (insent date) to (insert date)
El Entire Medical Record, inclüdiñ¡i patient histories, office notes (except p•ycha±==_py notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
dother·
W2 a sid sids )L 4.hd) /® f# CO)fb Include: (1mlicate by Initi:r!i:rg)
-frowl T i3honyrfsed Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By initialing here I authorize
fm als Nameofindividualhcalth care provider
to discuss my health information with my attorney, or a govemmental agency, listed here:
__ JAttomey/Firm Name or Govemmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
0 At request of individual
Other. litigation equirement end of IItigation
la
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
All items on this form have been comp!-ted and my qu±±i±-- about this form have been answered. In addition, I have been pmvided a
copy of the form.
Date: 7 2/
ign of patient or repre:=t=tive authorized by law.
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which resasably could
someone as having IHV symptoms or infection and information
identify regarding a person's contacts.
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
License Number
THE CITY OF NEW YORK
OFFICE OF THE CITY CLERK u-2ooo-soso
M-2011-8
\ l \ RR I \( W I K E W Bf R fi.\U
0Itttlfitatt if0artiage Ecgistratfort
of
This is To Certify That JOSEPH ANTHONY ITu.RA
residing at 699 10th Ave Aparti6ént # 4RN, New York, NY 10036. United States
1974 at New York New York United States
born on
TABETHAIRIS ISABEL QUILES New Sumame : ITARA
and
699 10th Ave Apartment # 4RN, New York, NY 10036, United States
residing at
978 Brooklyn New York United States
03/03/2000 '. Clerk
On
By Maria Roddguez
NY C, N ..
nited States
as shown by the duly registered license and t erú1hate m mamage of said persons on file in this office.
Cl:RTll-lEI) I II15 luTii .\ L THis (TFY CLERK S OFFICE
Manhattan April 28, 11
PLEASE NOTE: Facsimile Signature .
and seal are printed pursuant
to Section 1l-A. Domestic
Relations Law of New York. Mi elMcSwêêacy.
he City ofNew York
d ,
MO91110
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
--..-----...-. -.......-...---------------------------X Index No.: 152948/2020
JOSEPH ITARA and TABETHA ITARA,
Plaintiffs,
- against -
MASARYK TOWERS CORPORATION d/b/a
MASARYK TOWERS MANAGEMENT,
Defendants.
-¬----......--X
RESPONSE TO DEMANDS FOR DISCOVERY & INSPECTION
BRAND BRAND NOMBERG & ROSENBAUM, LLP
Attorneys for Plaint fs
7th
622 Third Ave, FlOOr
New York, New York 10017 ,
(212) 808-0448
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021
SUPREME COURT OF
Preview
FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 EXHIBIT “G” EXHIBIT “G” FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK ----X Index No.: 152948/2020 JOSEPH ITARA and TABETHA ITARA, Plaintiffs, RESPONSE TO DEMANDS FOR -against- DISCOVERY & INSPECTION MASARYK TOWERS CORPORATION d/b/a MASARYK TOWERS MANAGEMENT, Defendants. ----- ----------------------------.----.----..---------X COUNSELLORS: Plaintiff JOSEPH ITARA as and for his Response to the demands of the defendanta MASARYK TOWERS CORPORATION d/b/a MASARYK TOWERS MANAGEMENT Demands for Discovery & Inspection, sets forth as follows: EABILSTATEM_1EET.E None other than the accident report defense counsel exchanged. TELEMEDICINE RECORDS All authorizations provided include all medical records, which includes those taken by telemedicine. MOTICE TO PRODUCE AND PRESERVE Attached are 5 color copies of photographs of the type of boots plaintiff was wearing at the time of the sccident. Plaintiff is unsure whether these were the same boots he wore at the time of the accident. SUBSEQUENT INJIJRIES None. FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 MEDICAL AUTHORIZATIONS Steven Touliopoulos- Orthopedics of NY, PLLC University 31" 23-25 Street, Suite 800 Astoria, New York 11105 Surgicare of Manhattan 2nd 7th 800 Avenue, Floor New York, NY 10017 Dr. Daniel Klein 79th 229 East New York, NY 10075 EMPLOYMENT RECORDS Annexed hereto is a duly-executed authorization to obtain the plaintiff JOSEPH ITARA's employment W-2 wage statements and attendance records from 8/13/2017- records, specifically present, from: Centers1ial Elevator Industries 47th 24-35 Street Astoria, NY 11103 MARRIAGE CERTIFICATE plaintiffs' Annexed hereto is a copy of the marriage certificate. Dated: Westchester, New York June 2, 2021 BRAND BRAND NOMBERG & ROSENBAUM, LLP Attorneys for the Plaintifs By: Brett J. Nomberg, Esq. 7th 622 Third Ave, Floor New York, NY 10017 Tel. (212) 808-0448 FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 TO: MILBER MAKRIS PLOUSADIS & SEIDEN, LLP Attorneys for the Defendant MASARYK TOWERS CORPORATION d/b/a MASARYK TOWERS MANAGEMENT 1000 Woodbury Road, Suite 402 Woodbury, NY 11797 (516)712-4000 FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 . ^ * FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 L FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 e. FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 t e FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 M 1 FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Depadment of Health] Patient Name Date of Birth Social Security Number JOSEPH ITARA 974 Patient Address 520 West 56th Street, Apt 8D, New York, NY 10019 I, or my authorized representative, request that health kfesscicñ regarding my care and tmatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and AccomeiPy Act of 1996 (HIPAA), I understand that: I. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH HIV* RELATED TREATMENT, except psychotherapy notes, and CONFIDENTIAL INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health inicññation described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such infañaaticñ to the person(s) indicated in Item 8. 2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the acipient is prohibited from redisclosing such infarmation without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related ½hra=*½a without authorization. If I experience disd-i=±ª-r.. because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human at (212) 480-2493 Rights or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecthg my rights. 3. I have the right to revoke this authorization at eny time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATI'ORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). 7. Name and address of health provider to release this information: Ñ or entity WNoiÅC f6dn5Ô AtS ÑLi 23-26 D-h i SR.DÛ Å5% 4/Ô6 8. Name and address of person(s) or person to whom this information will be sen 9(a). Specific information to be released: Q Medical Record from (insert date) to (insert date) a Entire Medical Record, ire!üdkg patient histories, officenotes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. O Other: Include: (Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) Q By MM•!!q here I authorize s Name of individual health care provider to discuss my health im•*ien with my attorney, or a govemmental agency, listed here: (Attomey/Firm Name or Govemmental Agency Narne) 10. Reason for release of information: 11. Date or event on which this authorization will expire: Q At request of individual @ Other: litigation requirement end of litigation 12. If not the patient, name of person signing fotrn: 13. Authority to sign on behalf of patient All items on this form have been completed and my questions about this form have been answered. In edditis, I have been provided a copy of the form. too /O .tt Date: 7 Z / Z i of patient or representative authorized by law. * Haman Immunodeficiency Viras that causes AIDS. The New York State Pablie Health aw protects information which reasonably could someone as having HIV symptoms or ingsetlem and inibrmation identify regarding a persea's contacts, FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 OCA Official Form No.: 9dio AUTHORIZATION FOR RELEASE OF HEALTH DiFORMATION PURSUANT TO HIPAA |This ferm has been approved by the New York State Department of Health) Patient Name Date of Birth Soci urity Number JOSEPH ITARA 1974 713 Patient Address 520 West 56th Street, Apt SD, New York, NY 19019 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accc=±i!!•y Act of 1996 (HIPAA), I understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH HIV* TREATMENT, except psychotherapy notes, and CONFIDENTIAL RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of infbrmation, and I iaitial the line on the box in Item 9(a), I specifically authorize release of such inicitñâtica to the person(s) indicated in Item 8. 2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is pmMbi'M from redisclosing such information without my authorization unless parinitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Comminian of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or c::pt!iity for benefits not be conditioned will upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclasure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU 10 DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATIORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). 7. Name and address o health provide o entity to release this info ation: 8.Name and dress of person(s) or category of person to whom this information will be sent: 3ÂFr 15 ŸlClM i5 Å $d t tÚ70 O Piu f00t ${d†t 402- j Mod My ( Ï O47 9(a). Specific information to be released: O Medical Record from (insert date) to (insert date) B Entitt Medical Record, including patient histories, notes (except psychatharany office notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. 0 Other: Include: (Imticate by Initialing) Alcohol/Drug Treatament Mental Health Information Authorisation to Diseuss Health Information HIV-Related Information (b) O By initialing here I authorize Initials Name ofindividual health care pmvider to discuss my health information with my attomey, or a govemmental agency, listed here: (Attomey/Firm Name or Govemmental Agency Namc) 10. Reason for release of information: 11. Date or event on which this authorization will expire: 0 At request of individual @ Other litigadon requirement end of litigation 12. If not the patient, name of person signing fbrm: 13. Authority to sign on behalf of patient: All items on this form have been camph*M and my questions about this ibnn have been answered. In addition, I have been pmvided a copy of the form. gnature f patient or representative authorized by law. * Human Immunodeficiesey Virns that causes AIDS. The New York State Publie Health Law protects information whieb reasonably could someone as having HIV symptoms or inibction and Information regarding a person's contacts. identify FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 OCA OBicial Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form bas been approved by the New York State Department of Health] Patient Name Date of Birth Number JOSEPH ITARA 1974 713 Patient Address 520 West 56th Street, Apt SD, New York, NY 10019 I, or my authorized representative, request that health i+-•% regarding my care and tr=tm=t be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance P~*•hility and A~•~=*Amty Act of 1996 (HIPAA), I understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH except psychotherapy HIV* RELATED TREATMENT, notes, and CONFIDENTIAL INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of hfe--don, and I initial the line on the box in Item 9(a), I specifically authorize release of such hfa---ation to the person(s) Indicated in Item 8. 2. If I am authorizing the release of HIV-related, alcohol or dmg treatment, or mental health treatment information, the recipient is prohibited ilrom reisdsisg such information without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related infc-.":: without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, in a health plan, or eligibilitymW* for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE _OTHER THAN THE ATfORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). to release this inform::tiom g 7. Name and address of health provider or entity (ìr-bwd id 229 Gast #$hedi N a ¾# 4075 8. Name and address of erson(s) or category of person to whom this ½-a*ion will be so t: li f \5 ÊÍdúb1 (5 h#2GA LL f / 1 Di) Woalbge.oad suA w24 k9 m/ its 9(a). Specific information to be released: 0 Medical Record from (insert date) . to (insert date) Entire Medical Record, hehdes patient histories, office notes (except psyche±~•py notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. O Other: Include: (Indicate by Initiating) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By inith!iag here I authorize I tals Name of individual health care pmvider to discuss my health liifctitiation with my attomey, or a g-caa=ntal agency, listed here: (Attorney/Finn Name or Govemmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: 0 At request of individual a Other: litigation requiremnent end of litigation 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient· All items on this form have been completed and my questions about this form have been •.a.-a-d. in addition, I have been provided a copy of the form. .- 4i mas dÄhÅ Date: 7 2/ 2 // agnatu of pation or representative authorized by law. * Human imm••-deff clemey Virus that causes AIDS. The New York State Pablie ealth Law protects information which reasonably could identi$ someone as baving HIV symptoms or infhction and laformation regarding a person's contacts. FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 OCA Ofileial Form No.: 960 AUTHORIZATION FOR RELEASEOF HEALTH INFORMATION PURSUANT TO HIPAA [This form bas been appmved by the New York State Department of Health] Patient Name Date of Birth Social Security Number JOSEPH ITARA 974 Patient Address _520 West 56th Street, Apt 8D, New York, NY 10019 I, or my e±e±•d representative, request that health B- regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 19% (HIPAA), I understand that: 1. This authorization may include discloswe of info=cti= relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH HIV* TREATMENT, except pt--hetherapy notes, and CONFIDENTIAL RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health infama*ian described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without authnriwinn unless pc=it‡cd to do so under federal or state law. I my understand that I have the right to request a list of people who may receive or use my HIV-related Lafen==‡ica without authorization. If I experience discrimin=+ian because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Hurnan Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke except to the extent that action has already been taken based on this authorization. this authorization 4. I understand that signing this authorization is voluntary. My treatment payment, er!!me=± in a health plan, or cliphility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this e"d-^±±= might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATfORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). 7. Name and address of health provider or entity to release this information: 8. Name address of person(s) or category of person to whom this infe==•ion will be sent: ÎÓ l bT 0Wl a PÔW1 .LÊ/ / (flb kidblis - it g ()0ÔÏ7¼rt / K777 9(a). Specific infcmetion to be released: 0 Medical Record from (insent date) to (insert date) El Entire Medical Record, inclüdiñ¡i patient histories, office notes (except p•ycha±==_py notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. dother· W2 a sid sids )L 4.hd) /® f# CO)fb Include: (1mlicate by Initi:r!i:rg) -frowl T i3honyrfsed Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By initialing here I authorize fm als Nameofindividualhcalth care provider to discuss my health information with my attorney, or a govemmental agency, listed here: __ JAttomey/Firm Name or Govemmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: 0 At request of individual Other. litigation equirement end of IItigation la 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: All items on this form have been comp!-ted and my qu±±i±-- about this form have been answered. In addition, I have been pmvided a copy of the form. Date: 7 2/ ign of patient or repre:=t=tive authorized by law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which resasably could someone as having IHV symptoms or infection and information identify regarding a person's contacts. FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 License Number THE CITY OF NEW YORK OFFICE OF THE CITY CLERK u-2ooo-soso M-2011-8 \ l \ RR I \( W I K E W Bf R fi.\U 0Itttlfitatt if0artiage Ecgistratfort of This is To Certify That JOSEPH ANTHONY ITu.RA residing at 699 10th Ave Aparti6ént # 4RN, New York, NY 10036. United States 1974 at New York New York United States born on TABETHAIRIS ISABEL QUILES New Sumame : ITARA and 699 10th Ave Apartment # 4RN, New York, NY 10036, United States residing at 978 Brooklyn New York United States 03/03/2000 '. Clerk On By Maria Roddguez NY C, N .. nited States as shown by the duly registered license and t erú1hate m mamage of said persons on file in this office. Cl:RTll-lEI) I II15 luTii .\ L THis (TFY CLERK S OFFICE Manhattan April 28, 11 PLEASE NOTE: Facsimile Signature . and seal are printed pursuant to Section 1l-A. Domestic Relations Law of New York. Mi elMcSwêêacy. he City ofNew York d , MO91110 FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK --..-----...-. -.......-...---------------------------X Index No.: 152948/2020 JOSEPH ITARA and TABETHA ITARA, Plaintiffs, - against - MASARYK TOWERS CORPORATION d/b/a MASARYK TOWERS MANAGEMENT, Defendants. -¬----......--X RESPONSE TO DEMANDS FOR DISCOVERY & INSPECTION BRAND BRAND NOMBERG & ROSENBAUM, LLP Attorneys for Plaint fs 7th 622 Third Ave, FlOOr New York, New York 10017 , (212) 808-0448 FILED: NEW YORK COUNTY CLERK 09/07/2021 05:17 PM INDEX NO. 152948/2020 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 09/07/2021 SUPREME COURT OF